INCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATION
BACKGROUND OF THE INVENTION
Field of the Invention
[0002] The present invention relates to medical devices and procedures. More particularly,
the present invention relates to devices and methods for securing soft tissue to a
rigid material such as bone. Systems and methods are disclosed herein of fixing tissue
such as tendon or ligament to bone in orthopedic procedures.
Description of the Related Art
[0003] There are several medical procedures where a surgeon needs to attach soft connective
tissue such as tendons or ligaments to bone. One common example is an anterior cruciate
ligament ("ACL") reconstruction, a surgical procedure usually performed for the treatment
of a torn ACL. The ACL is one of four major ligaments of the knee. An ACL reconstruction
may be performed as an isolated procedure, but is often performed alongside the treatment
of meniscus tears and cartilage injuries as part of a multiple-repair surgery.
[0004] An ACL reconstruction is a procedure that replaces the injured ACL with a tissue
graft generally formed from the patient's patellar tendon or hamstring tendon or the
ligament of a cadaver. To perform an ACL reconstruction, a surgical procedure is used,
typically requiring the multiple steps of: harvesting and sizing the tissue graft,
securing the tissue graft to the end of a pin, removing the existing damaged ACL,
drilling a tunnel that creates a bore through the tibial bone and a blind hole in
the femoral bone, passing the pin and tissue graft through the bore and into the blind
hole, and screwing a first anchor into the blind hole of the femur and a second anchor
into the bore of the tibia to capture the tissue graft against the bone and solidly
affix the tissue to the bone. Even as an isolated procedure, ACL reconstruction is
difficult to perform arthroscopically. Systems recently brought to market still require
multiple steps and tools.
SUMMARY OF THE INVENTION
[0005] Disclosed herein are various embodiments of bone anchors and methods for performing
anterior cruciate ligament (ACL) repair that may address the aforementioned needs.
In some embodiments of the present invention, there is provided a method of anterior
cruciate ligament (ACL) repair, comprising forming a bone tunnel in a tibia, wherein
the bone tunnel comprises a proximal opening on one side of the tibia and a distal
opening on an opposite side of the tibia, passing soft tissue through the bone tunnel,
securing the soft tissue to a femur, inserting an anchor into a proximal opening of
the bone tunnel to a position where a distal end of the anchor is adjacent to a distal
opening of the bone tunnel, wherein the anchor comprises an expandable anchor body
having an internal cavity and a spreader, and sliding the expander into the internal
cavity, thereby causing at least a portion of the anchor body to expand outward, wherein
upon completion of the expansion, at least a portion of the anchor body adjacent to
the distal opening of the bone tunnel is expanded.
[0006] In some embodiments of the present invention, upon insertion of the anchor, the anchor
extends substantially the entire length of the bone tunnel. In some embodiments upon
expansion of the anchor, at least a portion of the anchor is not expanded outward.
In further embodiments, the portion not expanded outward comprises an anchor tip.
[0007] In some embodiments of the present invention, there is provided a method of ACL repair,
comprising forming a bone tunnel in a tibia, wherein the bone tunnel comprises a proximal
opening on one side of the tibia and a distal opening on an opposite side of the tibia,
passing soft tissue through the bone tunnel, securing the soft tissue to a femur,
inserting an anchor into a proximal opening of the bone tunnel to a position where
a distal end of the anchor is adjacent to a distal opening of the bone tunnel, wherein
the anchor is greater than about 30 mm long and comprises an expandable anchor body
having an internal cavity and a spreader, and sliding the expander into the internal
cavity, thereby causing at least a portion of the anchor body to expand outward, wherein
upon completion of the expansion, at least a portion of the anchor body adjacent to
the distal opening of the bone tunnel is expanded.
[0008] In some embodiments of the present invention, there is provided a method of ACL repair,
comprising forming a bone tunnel in a tibia, wherein the bone tunnel comprises a proximal
opening on one side of the tibia and a distal opening on an opposite side of the tibia,
passing soft tissue through the bone tunnel, securing the soft tissue to a femur,
inserting an anchor into a proximal opening of the bone tunnel to a position where
a distal end of the anchor is adjacent to a distal opening of the bone tunnel, wherein
the anchor is greater than about 35 mm long and comprises an expandable anchor body
having an internal cavity and a spreader, and sliding the expander into the internal
cavity, thereby causing at least a portion of the anchor body to expand outward, wherein
upon completion of the expansion, at least a portion of the anchor body adjacent to
the distal opening of the bone tunnel is expanded.
[0009] In some embodiments of the present invention, there is provided a method of ACL repair,
comprising forming a bone tunnel in a tibia, wherein the bone tunnel comprises a proximal
opening on one side of the tibia and a distal opening on an opposite side of the tibia,
passing soft tissue through the bone tunnel, securing the soft tissue to a femur,
inserting an anchor into a proximal opening of the bone tunnel to a position where
a distal end of the anchor is adjacent to a distal opening of the bone tunnel, wherein
the anchor is greater than about 40 mm long and comprises an expandable anchor body
having an internal cavity and a spreader, and sliding the expander into the internal
cavity, thereby causing at least a portion of the anchor body to expand outward, wherein
upon completion of the expansion, at least a portion of the anchor body adjacent to
the distal opening of the bone tunnel is expanded.
[0010] In other embodiments of the present invention, there is provided a method of anterior
cruciate ligament (ACL) repair, comprising forming a bone tunnel in a tibia, wherein
the bone tunnel comprises a proximal opening on one side of the tibia and a distal
opening on an opposite side of the tibia, passing soft tissue through the bone tunnel,
securing the soft tissue to a femur, inserting an anchor into a proximal opening of
the bone tunnel to a position where a distal end of the anchor is adjacent to a distal
opening of the bone tunnel, wherein the anchor comprises an expandable anchor body
having an internal cavity and a spreader, and inserting the expander into the internal
cavity, thereby causing at least a portion of the anchor body to expand outward, wherein
upon completion of the expansion, the expanded portion of the anchor body is expanded
substantially uniformly along its length.
[0011] In some embodiments of the present invention upon insertion of the anchor, the anchor
extends substantially the entire length of the bone tunnel. In some embodiments upon
expansion of the anchor, at least a portion of the anchor is not expanded outward.
In further embodiments the portion not expanded outward comprises an anchor tip.
[0012] In some embodiments of the present invention, there is provided a method of ACL repair,
comprising forming a bone tunnel in a tibia, wherein the bone tunnel comprises a proximal
opening on one side of the tibia and a distal opening on an opposite side of the tibia,
passing soft tissue through the bone tunnel, securing the soft tissue to a femur,
inserting an anchor into a proximal opening of the bone tunnel to a position where
a distal end of the anchor is adjacent to a distal opening of the bone tunnel, wherein
the anchor is greater than about 30 mm long and comprises an expandable anchor body
having an internal cavity and a spreader, and inserting the expander into the internal
cavity, thereby causing at least a portion of the anchor body to expand outward, wherein
upon completion of the expansion, the expanded portion of the anchor body is expanded
substantially uniformly along its length.
[0013] In some embodiments of the present invention, there is provided a method of ACL repair,
comprising forming a bone tunnel in a tibia, wherein the bone tunnel comprises a proximal
opening on one side of the tibia and a distal opening on an opposite side of the tibia,
passing soft tissue through the bone tunnel, securing the soft tissue to a femur,
inserting an anchor into a proximal opening of the bone tunnel to a position where
a distal end of the anchor is adjacent to a distal opening of the bone tunnel, wherein
the anchor is greater than about 35 mm long and comprises an expandable anchor body
having an internal cavity and a spreader, and inserting the expander into the internal
cavity, thereby causing at least a portion of the anchor body to expand outward, wherein
upon completion of the expansion, the expanded portion of the anchor body is expanded
substantially uniformly along its length.
[0014] In some embodiments of the present invention, there is provided a method of ACL repair,
comprising forming a bone tunnel in a tibia, wherein the bone tunnel comprises a proximal
opening on one side of the tibia and a distal opening on an opposite side of the tibia,
passing soft tissue through the bone tunnel, securing the soft tissue to a femur,
inserting an anchor into a proximal opening of the bone tunnel to a position where
a distal end of the anchor is adjacent to a distal opening of the bone tunnel, wherein
the anchor is greater than about 40 mm long and comprises an expandable anchor body
having an internal cavity and a spreader, and inserting the expander into the internal
cavity, thereby causing at least a portion of the anchor body to expand outward, wherein
upon completion of the expansion, the expanded portion of the anchor body is expanded
substantially uniformly along its length.
[0015] In other embodiments of the present invention, there is provided a method of anterior
cruciate ligament (ACL) repair, comprising forming a bone tunnel in a tibia, wherein
the bone tunnel comprises a proximal opening on one side of the tibia and a distal
opening on an opposite side of the tibia, passing soft tissue through the bone tunnel,
securing the soft tissue to a femur, measuring the length of the bone tunnel, selecting
an anchor from a plurality of possible anchors based on the measurement, inserting
the anchor into a proximal opening of the bone tunnel to a position where a distal
end of the anchor is adjacent to a distal opening of the bone tunnel, wherein the
anchor comprises an expandable anchor body having an internal cavity and a spreader,
and inserting the spreader into the internal cavity, thereby causing at least a portion
of the anchor body to expand outward, wherein upon completion of the expansion, at
least a portion of the anchor body adjacent to the distal opening of the bone tunnel
is expanded. In some embodiments selecting the anchor comprises selecting a length
of anchor among a plurality of possible lengths.
[0016] In other embodiments of the present invention, there is provided an expandable bone
anchor, comprising an anchor body and a spreader. The anchor body comprises a distal
tapered anchor tip and a plurality of rigid side portions extending proximally from
the anchor tip, each side portion coupled to the anchor tip through a double hinge.
The spreader is configured to advance distally into the anchor body, thereby causing
the rigid side portions to expand outward.
[0017] In some embodiments the spreader is coupled to the side portions. In some embodiments
the spreader is slidably coupled to the side portions. In further embodiments the
spreader comprises a plurality of longitudinal tracks and each side portion is coupled
to one of the tracks such that the side portions can slide longitudinally along the
tracks.
[0018] In some embodiments of the present invention, there is provided an expandable bone
anchor, comprising an anchor body and a spreader. The anchor body comprises a distal
tapered anchor tip and a plurality of rigid side portions extending proximally from
the anchor tip, each side portion coupled to the anchor tip through a double hinge.
The spreader is configured to advance distally into the anchor body, thereby causing
the rigid side portions to expand outward, wherein the spreader comprises at least
a portion that is tapered distally.
[0019] In some embodiments of the present invention, there is provided an expandable bone
anchor, comprising an anchor body and a spreader. The anchor body comprises a distal
tapered anchor tip and a plurality of rigid side portions extending proximally from
the anchor tip, each side portion coupled to the anchor tip through a double hinge.
The spreader is configured to advance distally into the anchor body, thereby causing
the rigid side portions to expand outward. In some embodiments the anchor tip comprises
a proximal locking member and the spreader comprises a distal locking member, wherein
the two locking members are configured to lock together upon maximal distal advancement
of the spreader. In further embodiments, the proximal locking member on the tip comprises
a post having an outwardly protruding ridge and the distal locking member on the spreader
comprises a hollow cylinder configured to receive the post. In further embodiments
the hollow cylinder comprises a groove on an inside surface configured to receive
the protruding ridge. In further embodiments the hollow cylinder comprises expandable
tabs.
[0020] In some embodiments of the present invention, there is provided an expandable bone
anchor, comprising an anchor body and a spreader. The anchor body comprises a distal
tapered anchor tip and a plurality of rigid side portions extending proximally from
the anchor tip, each side portion coupled to the anchor tip through a double hinge.
The spreader is configured to advance distally into the anchor body, thereby causing
the rigid side portions to expand outward, wherein upon maximal expansion, the rigid
side portions are expanded to a substantially uniform extent along their length.
[0021] In other embodiments of the present invention, there is provided an expandable bone
anchor, comprising an anchor body and a spreader. The anchor body comprises a distal
tapered anchor tip, a plurality of first expandable side portions, and a plurality
of second expandable side portions. The plurality of first expandable side portions
are positioned at a proximal end of the anchor body, wherein the first expandable
side portions expand by bending outward such that the first expandable side portion
extends outward to a greater extent at its proximal portion than at its distal portion.
The plurality of second expandable side portions are positioned distally of the first
expandable side portions, wherein the second expandable side portions expand by bending
outward such that the second expandable side portion extends outward to a greater
extent at its distal portion than at its proximal portion. The spreader is configured
to advance distally into the anchor body, thereby causing the first and second expandable
side portions to expand outward.
[0022] In some embodiments the first and second expandable side portions comprise bone-engaging
features. In further embodiments the bone engage features comprise teeth. In some
embodiments the bone engage features comprise ridges.
[0023] In some embodiments of the present invention, there is provided an expandable bone
anchor, comprising an anchor body and a spreader. The anchor body comprises a distal
tapered anchor tip, a plurality of first expandable side portions, and a plurality
of second expandable side portions. The plurality of first expandable side portions
are positioned at a proximal end of the anchor body, wherein the first expandable
side portions expand by bending outward such that the first expandable side portion
extends outward to a greater extent at its proximal portion than at its distal portion.
The plurality of second expandable side portions are positioned distally of the first
expandable side portions, wherein the second expandable side portions expand by bending
outward such that the second expandable side portion extends outward to a greater
extent at its distal portion than at its proximal portion. The spreader is configured
to advance distally into the anchor body, thereby causing the first and second expandable
side portions to expand outward, wherein the first and second expandable side portion
is formed by cuts in a side wall of the anchor body. In some embodiments the anchor
body tapers distally upon substantially its whole length. In some embodiments the
anchor tip has a hemispherical shape. In some embodiments the anchor tip has a conical
shape. In some embodiments the second expandable side portions comprise a protrusion
extending into a central cavity within the anchor body, wherein advancement of the
spreader into the central cavity causes the spreader to contact the protrusion, thereby
causing the second expandable side portions to expand outward.
[0024] In some embodiments of the present invention, there is provided an expandable bone
anchor, comprising an anchor body and a spreader. The anchor body comprises a distal
tapered anchor tip, a plurality of first expandable side portions, and a plurality
of second expandable side portions. The plurality of first expandable side portions
are positioned at a proximal end of the anchor body, wherein the first expandable
side portions expand by bending outward such that the first expandable side portion
extends outward to a greater extent at its proximal portion than at its distal portion.
The plurality of second expandable side portions are positioned distally of the first
expandable side portions, wherein the second expandable side portions expand by bending
outward such that the second expandable side portion extends outward to a greater
extent at its distal portion than at its proximal portion. The spreader is configured
to advance distally into the anchor body, thereby causing the first and second expandable
side portions to expand outward, wherein the spreader comprises at least a portion
that is tapered distally.
[0025] In some embodiments of the present invention, there is provided an expandable bone
anchor, comprising an anchor body and a spreader. The anchor body comprises a distal
tapered anchor tip, a plurality of first expandable side portions, and a plurality
of second expandable side portions. The plurality of first expandable side portions
are positioned at a proximal end of the anchor body, wherein the first expandable
side portions expand by bending outward such that the first expandable side portion
extends outward to a greater extent at its proximal portion than at its distal portion.
The plurality of second expandable side portions are positioned distally of the first
expandable side portions, wherein the second expandable side portions expand by bending
outward such that the second expandable side portion extends outward to a greater
extent at its distal portion than at its proximal portion. The spreader is configured
to advance distally into the anchor body, thereby causing the first and second expandable
side portions to expand outward, wherein the spreader has a substantially constant
diameter along its length. In some embodiments the spreader comprises a circumferential
ridge positioned at or adjacent to its proximal end.
BRIEF DESCRIPTION OF THE DRAWINGS
[0026] The above-mentioned aspects, as well as other features, aspects, and advantages of
the present technology will now be described in connection with various embodiments,
with reference to the accompanying drawings. The illustrated embodiments, however,
are merely examples and are not intended to be limiting.
FIGURE 1 depicts a perspective proximal view of one embodiment of a tissue anchoring
device in an unexpanded/undeployed state.
FIGURE 2A depicts a perspective distal view of one embodiment of an anchor body in
an unexpanded state.
FIGURE 2B depicts a perspective proximal view of one embodiment of an anchor body
in an unexpanded state.
FIGURE 3A shows a perspective proximal view of one embodiment of a spreader.
FIGURE 3B shows a perspective distal view of one embodiment of a spreader.
FIGURE 3C shows a cross-sectional view of one embodiment of a spreader.
FIGURE 4 shows a perspective view of one embodiment of a distal tip of an anchor body.
FIGURE 5A depicts a perspective view of one embodiment of a tissue anchoring device
in an unexpanded/undeployed state.
FIGURE 5B depicts a perspective proximal view of one embodiment of a tissue anchoring
device in an expanded/deployed state.
FIGURE 6A shows a perspective view of one embodiment of a tissue anchoring device
in an unexpanded/undeployed state.
FIGURE 6B shows a perspective view of one embodiment of a tissue anchoring device
in an expanded/deployed state.
FIGURE 6C shows a front view of one embodiment of a tissue anchoring device in the
expanded/deployed state.
FIGURE 7A shows a cross-sectional view of one embodiment of a tissue anchoring device
in which the tissue anchoring device has partially deployed or expanded.
FIGURE 7B shows a cross-sectional view of another embodiment of a tissue anchoring
device in which the tissue anchoring device has partially deployed or expanded.
FIGURE 8A depicts a perspective distal view of one embodiment of an anchor body in
an unexpanded/undeployed state.
FIGURE 8B depicts a perspective proximal view of one embodiment of an anchor body
in an unexpanded/undeployed state.
FIGURE 9A depicts a perspective distal view of one embodiment of a spreader.
FIGURE 9B depicts a perspective proximal view of one embodiment of a spreader.
FIGURE 10A depicts a side view of one embodiment of a tissue anchoring device attached
to an inserter tool and covered by a sleeve.
FIGURE 10B depicts a perspective view of one embodiment of a tissue anchoring device
attached to an inserter tool with the sleeve retracted.
FIGURE 11 depicts a perspective distal view of one embodiment of a tissue anchoring
device in an unexpanded/undeployed state.
FIGURE 12 depicts a perspective distal view of one embodiment of an anchoring body
in an unexpanded/undeployed state.
FIGURE 13 depicts a perspective proximal view of one embodiment of a spreader.
FIGURE 14 depicts a perspective distal view of one embodiment of a tissue anchoring
device in an expanded/deployed state.
FIGURE 15A shows an exploded view of one embodiment of an inserter tool.
FIGURE 15B shows a perspective view of one embodiment of an inner rod component of
an insertion tool.
FIGURE 15C shows a perspective view of one embodiment of an outer tube component of
an insertion tool.
FIGURE 15D shows a side view of one embodiment of a handle component of an insertion
tool.
FIGURE 15E shows a perspective view of one embodiment of a handle component of an
insertion tool.
FIGURE 15F shows a perspective view of one embodiment of an actuator shaft component
of an insertion tool.
FIGURE 15G shows a perspective view of one embodiment of a deployment knob component
of an insertion tool.
FIGURE 16A shows a perspective view of one embodiment of a femoral tissue capture
anchor device in an undeployed or unexpanded state.
FIGURE 16B shows a perspective view of one embodiment of a femoral tissue capture
anchor device in a deployed or expanded state.
FIGURE 17 shows a perspective view of one embodiment of a tissue anchoring device
comprising a tissue capture suture loop.
FIGURES 18A-18D depict four frontal views of the bones surrounding the human knee
and one embodiment of a method of securing soft tissue to the bones using a tissue
anchoring device.
DETAILED DESCRIPTION OF THE CERTAIN EMBODIMENTS
[0027] In the following detailed description, reference is made to the accompanying drawings,
which form a part of the present disclosure. In the drawings, similar symbols typically
identify similar components, unless context dictates otherwise. The illustrative embodiments
described in the detailed description, drawings, and claims are not meant to be limiting.
Other embodiments may be utilized, and other changes may be made, without departing
from the spirit or scope of the subject matter presented herein. It will be readily
understood that the aspects of the present disclosure, as generally described herein,
and illustrated in the Figures, can be arranged, substituted, combined, and designed
in a wide variety of different configurations, all of which are explicitly contemplated
and form part of this disclosure.
[0028] The terminology used herein is for the purpose of describing particular embodiments
only and is not intended to be limiting of the disclosure. It will be understood by
those within the art that if a specific number of a claim element is intended, such
intent will be explicitly recited in the claim, and in the absence of such recitation,
no such intent is present. For example, as used herein, the singular forms "a", "an"
and "the" are intended to include the plural forms as well, unless the context clearly
indicates otherwise. As used herein, the term "and/or" includes any and all combinations
of one or more of the associated listed items. It will be further understood that
the terms "comprises," "comprising," "have," "having," "includes," and "including,"
when used in this specification, specify the presence of stated features, integers,
steps, operations, elements, and/or components, but do not preclude the presence or
addition of one or more other features, integers, steps, operations, elements, components,
and/or groups thereof. Expressions such as "at least one of," when preceding a list
of elements, modify the entire list of elements and do not modify the individual elements
of the list.
[0029] To assist in the description of the devices and methods described herein, some relational
and directional terms are used. As recited within this disclosure, the "longitudinal
axis" of a bone or component is the elongated axis running through the length of the
bone or component.
[0030] "Connected" and "coupled," and variations thereof, as used herein include direct
connections, such as being contiguously formed with, or glued, or otherwise attached
directly to, on, within, etc. another element, as well as indirect connections where
one or more elements are disposed between the connected elements. "Connected" and
"coupled" may refer to a permanent or non-permanent (i.e., removable) connection.
[0031] "Secured" and variations thereof as used herein include methods by which an element
is directly secured to another element, such as being glued, screwed, or otherwise
fastened directly to, on, within, etc. another element, as well as indirect means
of securing two elements together where one or more elements are disposed between
the secured elements.
[0032] "Proximal" and "distal" are relational terms used herein to describe position from
the perspective of a medical professional positioning a tissue anchoring device. For
example, as compared to "distal," the term "proximal" refers to a position that is
located more closely to the medical professional once inserted or implanted during
surgery. Often, the proximal end of the fixation device includes, for example, the
end that abuts an insertion tool. The distal end opposes the proximal end and often
includes, for example, the end configured to be pushed furthest into a bone tunnel
in a patient.
[0033] Embodiments disclosed herein relate to tissue anchoring devices and methods of anchoring
soft tissue, such as for example, tendons or ligaments, to bone. The tissue anchoring
devices of the present disclosure are each configured with multiple fixation sites
along the length of the device.
[0034] Some embodiments disclosed herein relate generally to anchors for use in anchoring
tissue or objects in a body. More specifically, some embodiments disclosed herein
relate generally to anchors for use in anchoring soft tissue to bone in a body. Also
some elements relate to individual components and subcomponents of the systems described
herein, as well as methods of making and using the same. Some embodiments additionally
relate to kits and components used in connection with the anchor. Although the following
embodiments refer to the use of an anchor in anchoring tissue, a person of skill in
the art will recognize that an anchor can be used to anchor any range of items within
a body.
[0035] Various embodiments disclosed herein relate to anchors configured to attach soft
tissue to bone, such as, for example, to attach an anterior cruciate ligament ("ACL")
graft within a bone tunnel of a tibial bone. As described in more detail below with
reference to individual embodiments, various anchors disclosed herein are configured
to extend through substantially the length a bone tunnel. In some such embodiments,
the anchors are configured to provide for expansion and fixation along the length
of the anchor. In other embodiments disclosed herein, the anchors are configured to
provide for expansion and fixation at various points along the length of the anchor.
[0036] Figure 1A depicts a perspective view of one embodiment of a tissue anchoring device
100. The tissue anchoring device 100 of the current embodiment includes an anchor
body 200 and a spreader 300. The spreader 300 is configured to slidably fit within
a central bore of the anchor body 200.
[0037] Figure 1B depicts a perspective view of one embodiment of a tissue anchoring device
100 in an expanded or deployed state. The tissue anchoring device 100 of the current
embodiment includes an anchor body 200 and a spreader 300. The spreader 300 is configured
to slidably fit within a central bore of the anchor body 200.
[0038] The anchor body 200, shown in more detail in Figures 2A and 2B, includes four panels
210 (i.e., rigid side portions). In other embodiments, a different number of panels
210 may be present, such as, for example, three, five, six, seven, or eight panels
210. In various embodiments, when the panels 210 are in a first, unexpanded position,
each panel 210 abuts a neighboring panel 210 on at least two sides. Each panel 210
has an outer surface 212 and an inner surface 214. In some embodiments, the outer
surfaces 212 of the panels 210 together define the at least a portion of the shape
of the anchor body 200. The outer surface 212 of each panel 210 includes one or more
flat faces (e.g., faces 213a, 213b, and 213c). In such embodiments, when the panels
210 are in an unexpanded position, their outer surfaces 212 form a polyhedron. In
other embodiments, the outer surface 212 of each panel 210 has a rounded face, and
together the outer surfaces 212 of the panels 210 form a cylinder in an unexpanded
position. In other embodiments, such as in Figure 2A, the panels 210 have both rounded
faces 213a, 213c and non-rounded faces 213b on the outer surface 212. In various embodiments,
when the panels 210 are in an unexpanded position, the tissue anchoring device 100
is in a streamlined position such that there is little to no protrusion of the panels
210 radially outward. In some embodiments, the panels 210 are substantially rigid
and do not flex during operation.
[0039] As shown in Figure 2A, in various embodiments, the inner surfaces 214 of the panels
210 surround and define a central bore 265. Additionally, in some embodiments, the
inner surface 214 of each panel 210 has a plurality of faces. For example, as shown
in Figure 2B, the inner surface 214 of some embodiments includes at least three faces
(e.g., faces 215a, 215b, and 215c), which together define a groove 220. As described
in more detail below, in various embodiments, the groove 220 is configured to receive
a protrusion or track of the spreader 300.
[0040] In some embodiments, the panels 210 and the central bore 265 extend nearly the entire
length of the anchor body 200. In some such embodiments, the anchor body 200 includes
a distal tip 260 coupled to a distal end of the panels 210, which limits the panels
210 from actually extending the entire length of the anchor body 200. In various embodiments,
the distal tip 260 is closed and rounded. As shown in Figure 2B, each panel 210 is
attached to the distal tip 260 via a hinge element 225. The distal tip 260 of some
embodiments acts as a base of direct or indirect connection for the plurality of panels
210. In some embodiments, each hinge element 225 includes two pivoting connections
(i.e., forming a double hinge)-a distal pivot 224 at a distal side of the hinge element
225, pivotally connecting the hinge element 225 to the distal tip 260, and a proximal
pivot 226 at a proximal side of the hinge element 225, pivotally connecting the hinge
element 225 to a panel 210.
[0041] In some embodiments, the panels 210 are configured to move from an unexpanded position
to an expanded position via pivoting about the distal pivot 224 and the proximal pivot
226. In various embodiments, the panels 210 are urged to move from the unexpanded
position to the expanded position upon insertion of a spreader 300 into the central
bore 265 of the anchor body 200. The spreader 300, shown in more detail in Figures
3A-3C, is shaped and configured to facilitate displacement of the panels 210 of the
anchor body 200.
[0042] Figure 3A shows a perspective proximal view of a spreader and Figure 3B shows a perspective
distal view, and Figure 3C shows a cross-sectional view of the spreader. The spreader
300 of Figures 3A-3C has a substantially tubular body 310 with tracks 320 disposed
on an outer surface 312 of the tubular body 310. The tracks 320 of some embodiments
run longitudinally along the outer surface 312 from a distal portion of the spreader
300 to a proximal portion of the spreader 300. In some embodiments, the tracks 320
are complementary in placement and shape to the grooves 220 of the anchor body 200,
and the tracks 320 are configured to fit within the grooves 220. The grooves 220 and
the tracks 320 may include additional complementary features such as ridges 321, indentations
322, bumps 323, dimples, protrusions, recesses, and the like, designed to lock the
track 320 within the groove 220. When the track 320 of the spreader 300 is locked
within the groove 220 of the anchor body 200, axial displacement and rotation of the
spreader 300 relative to the anchor body 200 is limited. Longitudinal displacement
of the track 320 relative to the groove 220 is still possible in the locked position.
It will be appreciated by those skilled in the art that in some embodiments, the complementary
features can be reversed such that the anchor body 200 includes a set of tracks or
protrusions and the spreader 300 includes a set of grooves or recesses.
[0043] In various embodiments, the tracks 320 are non-uniformly elevated from the outer
surface 312 of the tubular body 310 along a length of the spreader 300. For example,
in some embodiments, such as the embodiment of Figs. 3A and 3B, each of the tracks
320 is disposed on a wedge-like projection 330 (hereinafter, a "wedge"), which extends
radially outward from the tubular body 310. In various embodiments, the wedge 330
extends most radially outward at a proximal end of the spreader 300 and tapers radially
inward in the distal direction.
[0044] Also shown in Figure 3A is a depression 316 (e.g., a groove) circumferentially arranged
along an inner surface 314 of the spreader 300 at the distal end of the spreader 300.
The depression 316 is configured to engage with a portion of the distal tip 260, as
described in more detail below. In some embodiments, the depression 316 is located
on or within one or more bendable tabs 318. The bendable tabs 318 are defined by a
plurality of cuts 319 made into a distal end of the tubular body 310. The bendable
tabs are configured to bend outwardly, bending from a base of the cuts 319, when the
spreader 300 makes contact with a distal tip 260 of the anchor body.
[0045] Additionally, as shown best in Figures 3B and 3C, in various embodiments, the spreader
300 has an opening 380 leading into an inner channel 390 configured to receive and
couple to an insertion tool. One embodiment of an insertion tool 1000 is discussed
in more detail below.
[0046] One embodiment of a distal tip 260 of an anchor body 200 is depicted in Figure 4.
In various distal tip embodiments, the distal tip is substantially closed and rounded
to create a streamlined design. The shape of the distal tip 260 facilitates insertion
of the anchor body 200 into a bone tunnel and helps the anchor body 200 slide around
soft tissue positioned within the bone tunnel without causing injury to the tissue.
A small hole 290 may advantageously be provided in the center of the distal tip 260
to facilitate engagement of the anchor body 200 with an insertion tool. The small
hole 290 may be surrounded by threads configured to mate with threads on an inner
rod of the insertion tool. In some embodiments, the distal tip 260 includes a lip
262 (e.g., a protruding ridge) configured engage the depression 316 of the spreader
300. Engagement between the depression 316 of the spreader 300 and the lip 262 of
the distal tip 260 limits longitudinal movement of the spreader 300 and secures the
tissue anchor device 100 in an expanded state. The anchor body tip may additionally
include holes, pins, and or other features 266 for attaching the hinge element 225
to the distal tip 260 about a proximal pivot 226.
[0047] As shown in Figure 5A, in various embodiments, the distal end of the spreader 300
is configured to enter the central bore 265 at a proximal end of the anchor body 200.
In the provided illustration, the spreader 300 has entered the central bore, but has
not been advanced substantially into the central bore; as a result, the panels 210
are still in an unexpanded position. The spreader 300 is configured to continue advancing
distally deeper into the central bore by sliding within the grooves 220 of the anchor
body 200. The spreader 300 is configured to urge the panels 210 of the anchor body
200 radially outward relative to the central bore 265 upon insertion of the spreader
300 into the central bore as shown in Figure 5B, where the panels 210 are in an expanded
position.
[0048] With the anchor body 200 and the spreader 300 aligned such that the tracks 320 of
the spreader 300 are at least partially disposed within the grooves 220 of the anchor
body 200, sliding the spreader 300 into the central bore causes the panels 210 to
be displaced outward, following the taper of the spreader 300. This outward displacement
causes the panels 210 to separate from each other and causes the anchor body 200 to
expand. In various embodiments, the panels 210 are configured to engage with soft
tissue and bone when the panels 210 are pivoted to an expanded position, fixedly securing
the tissue anchoring device 100 and the soft tissue within a bone tunnel. As shown
in Figure 5B, in various embodiments, the entire length of each panel 210 is displaced
outwardly when the panels 210 are in an expanded position. The outward displacement
is possible due to pivoting about the proximal pivot 226 and the distal pivot 224.
[0049] In some embodiments, distal movement of the spreader 300 within the anchor body 200
leads primarily to pivoting about the proximal pivot 226 as the panels 210 are urged
further outward by the increasing diameter of the advancing wedge 330. In some such
embodiments, the spreader 300 can be inserted into the central bore of the anchor
body 200 until the depression 316 of the spreader 300 engages with the lip 262 of
the distal tip 260 (as shown in Figure 3C and Figure 4, respectively). Upon engagement
of the lip 262 with the depression 316, contact is made between the distal end of
the spreader 300 and the hinge elements 225, and a force is applied to the hinge elements
225, urging them to swing radially outward and pivot about the distal pivot 224. The
panels 210 transition to a fully expanded position when the hinge element 225 swings
outward about the distal pivot 224. In such an expanded position, the panels 210 extend
radially outward from the anchor body 200. In some embodiments, each panel 210 undergoes
relatively uniform expansion along the length of the panel 210. In other embodiments,
as depicted in Figure 5B, the panels 210 expand to a greater extent at their proximal
end as compared to their distal end.
[0050] In embodiments described herein, the outward displacement of the panels 210 and resultant
expansion of the anchor body 200 is achieved without the need for applying any torque
to the tissue anchoring device 100. Thus, advantageously, insertion and expansion
of the tissue anchoring devices 100 disclosed herein is likely to prevent any twisting
or turning of the soft tissue within a bone tunnel.
[0051] In various embodiments, the tissue anchoring device 100 is inserted into a bone tunnel
with the aid of an inserter tool, for example, inserter tool 3000. More details about
insertion tool 3000 are provided below.
[0052] Another embodiment of a tissue anchoring device 1100 is depicted in Figure 6A. The
anchor body 1200 is comprised of a tubular wall 1210 defining a central bore and having
compressible tabs 1220. In one embodiment the tubular wall 1210 is uniformly tubular
in that it comprises a uniform diameter. The compressible tabs 1220 are configured
to engage with soft tissue and bone, fixedly securing the anchor body 1200 and the
soft tissue in the bone. In some embodiments, the compressible tabs comprise one or
more teeth 1230 which are configured to further engage with the tissue and bone. The
number of compressible tabs 1220 and teeth 1230 can vary. The compressible tabs are
affixed to the tubular wall along an edge 1240. The edge 1240 is configured to allow
pivotal movement about the tubular wall such that the compressible tabs are bendable
between a compressed state and an expanded state. The tissue anchoring device also
comprises a spreader 1300, which is insertable into the central bore at the anchor
body's proximal end 1250 and configured to urge the compressible tabs 1220 radially
outward relative to the tubular wall 1210 upon insertion of the spreader into the
central bore. In Figure 6A, the spreader 1300 is in its undeployed or uninserted state
such that the compressible tabs 1220 are collapsed and in their compressible state.
In the embodiment depicted in Figure 6A, when the compressible tabs 1220 are in their
compressed state, the tissue anchoring device 1100 is in a streamlined position such
that there is little to no protrusion of the teeth 1230 radially outward beyond the
tubular wall.
[0053] In the tissue anchoring device embodiment of Figure 6A, the tissue anchoring device
1100 also includes a proximal-most portion 1205, which is outwardly expandable. Expansion
slots 1206 are cut into the anchor body 1200 at the proximal end and extend in a distal
direction such that the outwardly expandable proximal portion 1205 comprises a plurality
of expandable segments 1207 that are disconnected from each other. Each expandable
segment 1207 is connected to the remainder of the anchor body 1200 (i.e., to a non-expanding
distal portion of the anchor body 200) at a distal end of each respective expandable
segment 1207. In the depicted embodiment, the expandable segments 1207 are configured
to bend radially outward when the spreader 1300 is fully advanced distally into the
central bore 1265 of the anchor body 1200. In some embodiments, contact between an
inner surface of the anchor body 1200 and a ridge 1325 of the spreader 1300 creates
a force that urges the expandable segments 1207 radially outward.
[0054] In some embodiments, the tissue anchor 1100 is configured such that, when the tissue
anchor 1100 is placed in a properly-sized bone hole, the outwardly expandable proximal-most
portion 1205 is positioned within the cortical layer of bone near the aperture of
a bone tunnel. In such embodiments, the expandable segments 1207 may be tailored to
expand into the cortical layer and provide for cortical fixation. In other embodiments,
the expandable segments 1207 may be configured for cortical and subcortical engagement.
In various embodiments, each expandable segment 1207 has a sharp edge, one or more
ridges, teeth, or other protrusions 1208, which facilitate engagement of the expandable
segment 1207 with surrounding bone.
[0055] One embodiment of the tissue anchoring device is also depicted in Figure 6B. Figure
6B shows a perspective view in which the spreader 1300 has been inserted into the
central bore of the anchor body 1200, thus moving the compressible tabs 1220 into
their expanded state. In such an expanded state, the teeth 1230 extend radially outward
from the anchor body 1200 and are configured to engage with bone and fixedly secure
the tissue anchoring device 1100 within the bone. In the embodiment of Figure 6B,
the compressible tabs are positioned along circumferential rows. A first row 1270
contains compressible tabs located along a first axial position, and a second row
1280 contains compressible tabs located along a second axial position. In some embodiments,
the first row of tabs 1270 is offset circumferentially relative to the second row
of tabs 1280 such that no two compressible tabs 1220 share the same longitudinal alignment.
Such a configuration facilitates capture and fixation of a soft tissue by hindering
slippage of the soft tissue between the compressible tabs.
[0056] Figure 6C provides a front view of the embodiment described in Figure 6B. Figure
6C depicts compressible tabs 1230 in their expanded state and a first row of compressible
tabs 1270 offset circumferentially from a second row of compressible tabs 1280.
[0057] In some embodiments, the distal end 1260 of the anchor body is substantially rounded
to facilitate insertion of the anchor body into a bone tunnel and to slide around
tendon positioned within the bone tunnel. A small hole 1290 may advantageously be
provided in the center of the distal end 1260 to facilitate engagement of the anchor
body with an insertion tool, such insertion tool explained in subsequent paragraphs.
The small hole 1290 may comprise threads to mate with the threads on the inner rod
of the insertion tool.
[0058] In one embodiment of the tissue anchoring device, a plurality of compressible tabs
are located along the same axial position, forming circumferential rows of compressible
tabs. As shown in the cross-sectional view of Figure 7A, the compressible tabs move
about a hinge-like edge 1240, moving from a compressed state to an expanded state
upon insertion of the spreader 1300 through the proximal end 1250 of the anchor body
and into the central bore. In the expanded state, the compressible tabs 1220 are substantially
flush with the tubular wall and the teeth 1230 protrude radially outwardly relative
to the anchor body.
[0059] In another embodiment of the tissue anchoring device, there exists a plurality of
compressible tabs 1220, wherein all compressible tabs are offset axially relative
to one another. Figure 7B depicts a cross-sectional view of such an embodiment. With
the compressible tabs 1220 offset axially, such that no two tabs lie along the same
axial position, each tab can be configured to extend beyond the center line or central
axis of the central bore when the tab is in its compressed state. Such a configuration
allows for the inclusion of larger teeth 1230 on the compressible tab than would be
possible with many other embodiments, thus facilitating increased contact between
the teeth and bone.
[0060] One embodiment, described in the preceding paragraph, is further illustrated in the
perspective view provided in Figure 8A. In Figure 8A, the anchor body 1200 is shown
in isolation with the compressible tabs 1220 found in their compressed or undeployed
state. The anchor body 1200 is generally tubular or cylindrical in shape and is comprised
of a uniform diameter. The compressible tabs 1220 bend inward along the bendable edge
1240 such that the teeth 1230 are largely retracted into the central bore inside the
anchor body and do not extend substantially beyond the tubular wall 1210 prior to
insertion of the spreader. The compressible tabs 1220 are offset both axially and
circumferentially relative to each other.
[0061] Another embodiment of a compressed or undeployed anchor body is shown in the perspective
view of Figure 8B. In Figure 8B, the central bore defined by the tubular wall 1210
is visible from the proximal side of the anchor body. The anchor body of this embodiment
has an inner surface 1215 of the tubular wall which is in contact with a spreader
1300 when the spreader is inserted into the anchor body. In some embodiments, the
inner surface 1215 may be smooth. In other embodiments, in inner surface 1215 of the
anchor body and the surface of the spreader 1300 may not be smooth, but rather, may
be textured such as with a scallop shape or grooves so as to inhibit movement of spreader
1300 once it is pushed into the anchor body. In some embodiments, texturing in the
inner surface 1215 is complementary to texturing in the outer surface of the spreader
1300. Such a design prevents unintended retraction or over-insertion of the spreader.
In some embodiments, one or more complementary shapes, including multiple concentric
grooves, a series of protruding ridges, or any other suitable complementary structures
may be present on the inner surface 1215 of the anchor body 1200 and an outer surface
of the spreader 1300 to lock the spreader 1300 into place when the anchor body 1200
is fully deployed in order to prevent unintended retraction or over-insertion of the
spreader 1300.
[0062] To provide further details of the spreader, an embodiment of the spreader is depicted
in Figures 9A and 9B. The spreader 1300 may comprise any suitable shape configured
to be inserted through the central bore of the anchor body 1200. In the embodiment
of Figures 9A and 9B, the generally tapered distal end 1340 of the spreader is configured
to come into contact with the compressible tabs of the anchor body and facilitate
bending of the tabs into their expanded state upon insertion of the spreader into
the anchor body. The body 1310 of the spreader is uniformly tubularly shaped and surrounds
an axial bore configured for receiving an insertion tool. In this embodiment, the
tubular body 1310 of the spreader 1300 comprises a circumferentially located ridge
1325 near its proximal end 1320. As the tissue anchoring device is deployed, the spreader
1300 is advanced into the anchor body 1200, spreading the compressible tabs 1220 until
the ridge 1325 of the spreader 1300 engages the groove 1225 in the inner surface of
the anchor body. In one embodiment, the ridge 1315 may be undercut providing even
more security against reversing. The proximal end of the spreader comprises a generally
flat face and a means for receiving the insertion tool. For instance, in this embodiment,
the proximal end 1320 of the spreader 1300 comprises a hole 1330 that receives the
insertion tool. After deployment, the spreader remains in the deployed anchor and
the insertion tool's inner rod shears off from the anchor body such that the proximal
end of the spreader 1300 remains in the anchor in a state that is either flush or
slightly recessed with respect to the proximal end of the anchor body 1200.
[0063] The spreader 1300 will remain in the anchor body 1200 with the compressible tabs
1220 in their fully expanded position. The force provided by the interaction between
the compressible tabs, teeth and bone keeps the spreader 1300 tightly engaged. Further
protection against slipping or tilting of the spreader 1300 is provided by the optionally
ridged sides of the spreader 1300. In one embodiment, one or more of the compressible
tabs 1220 have an indentation on a side facing the central bore. A ridge on the spreader
1300 can then engage the indentation, thereby stabilizing the spreader 1300 and preventing
the spreader 1300 from being advanced too far into the anchor. In an alternative embodiment,
the spreader 1300 comprises an indentation that can engage with a protrusion on a
side of a compressible tab facing the central bore. In addition to stabilizing the
spreader 1300 and preventing over-insertion, this feature also prevents rotation of
the spreader 1300 relative to the anchor. Inserting the spreader 1300 into the anchor
body 1200 linearly, as opposed to twisting or screwing, is likely to be advantageous
in that the linear motion will create no tendency to rotate the anchor. Thus, a linear
approach is likely to prevent any twisting or turning of the captured soft tissue.
[0064] In one embodiment, illustrated in Figures 10A and 10B, the compressible tabs may
be of a thin enough material thickness such that they can be pushed in by a slidable
sleeve 1400 positioned over the anchor body 1200. The slidable sleeve 1400 is configured
to hold the compressible tabs 1200 in place substantially inside the anchor body 1200
during insertion of the anchor body 1200 into the bone tunnel. Figure 10A shows one
embodiment of the anchor body 1200 and slidable sleeve 1400 combination with the anchor
body 1200 in its compressed state and with the combination connected to the outer
tube 1600 of the insertion tool. The slidable sleeve 1400 can be withdrawn when the
anchor body 1200 is in place inside a bone, and the compressible tabs will at least
partially expand. The compressible tabs and teeth will completely expand according
to the method described herein upon insertion of the spreader 1300 using the insertion
tool 3000. Figure 10B depicts one embodiment of the anchor body 1200 and slidable
sleeve combination with the slidable sleeve 1400 in a retracted state such that the
compressible tabs 1220 of the anchor body 1200 have partially expanded and the teeth
1230 partially protrude radially outward from the tubular wall. In this depiction,
the spreader 1300 is held adjacent to the anchor body 1200 via the inserter tool 3000
prior to insertion of the inserter into the anchor body 1200.
[0065] An additional embodiment of a tissue anchoring device 2100 in provided in Figures
11-14. Similar to the tissue anchoring device 1100 embodiment described above, the
tissue anchoring device 2100 embodiment of Figure 11 is comprised of an anchor body
2200 and a spreader 2300. The spreader 2300 is configured to slide or advance into
a central bore 2265 of the anchor body 2200 without the need for applying torque.
[0066] As shown in Figure 12, in some embodiments, the anchor body 2200 comprises a tubular
wall 2210 defining a central bore 2265. In one embodiment the tubular wall 2210 is
uniformly tubular in that it comprises a uniform diameter. In other embodiments, the
tubular wall 2210 is tapered such that a distal diameter is smaller than a proximal
diameter. The taper of some embodiments facilitates insertion of the tissue anchoring
device 2100 into a bone tunnel. In some embodiments, the distal end 2260 of the anchor
body 2200 is substantially rounded to facilitate insertion of the anchor body into
a bone tunnel and to slide around tendon positioned within the bone tunnel. A small
hole 2290 may be provided in the center of the distal end 2260 to facilitate engagement
of the anchor body with an insertion tool, such insertion tool explained in subsequent
paragraphs. The small hole 2290 may comprise threads to mate with the threads on the
inner rod of the insertion tool. In some embodiments, the proximal end 2270 of the
anchor body 2200 is cut on a slant, such that one side of the tubular anchor body
extends longitudinally beyond another side of the tubular anchor body. Such a slant
may be included on the proximal end 2270 when used in a bone tunnel having a slanted
aperture at the entrance of the bone tunnel. Such a configuration may enable the proximal
end 2270 of the anchor body 2200 to sit flush with a bone surface when a bone tunnel
is drilled into a bone on an angle, as is often done.
[0067] The anchor body 2200 of Figure 12 also includes a proximal portion 2205 that is outwardly
expandable. As described in the previous anchor body 1200 embodiment, expansion slots
2206 are cut into the anchor body 2200 at the proximal end and extend in a distal
direction such that the outwardly expandable proximal portion 2205 comprises a plurality
of expandable segments 2207 (i.e., expandable side portions) that are disconnected
from each other. Each expandable segment 2207 is connected to the remainder of the
anchor body 2200 (i.e., to a non-expanding distal portion of the anchor body 2200)
at a distal end of each respective expandable segment 2207. The expandable segments
2207 are configured to bend radially outward when the spreader 2300 is fully advanced
distally into the central bore 2265 of the anchor body 2200. In some embodiments,
the tissue anchor 2100 is configured such that, when the tissue anchor 2100 is placed
in a properly-sized bone hole, the outwardly expandable proximal-most portion 2205
is positioned within the cortical layer of bone near the aperture of a bone tunnel.
The expandable segments 2207 may be configured for cortical and/or subcortical engagement.
In various embodiments, each expandable segment 2207 has a sharp edge, one or more
ridges, teeth, or other protrusions 2208, which facilitate engagement of the expandable
segment 2207 with surrounding bone.
[0068] Also shown in Figure 12, in some embodiments, the anchor body 2200 has a plurality
of expandable segments 2220 (i.e., expandable side portions) located on a more distal
half of the anchor body 2200. The expandable segments 2220 are configured to be displaced
radially outwardly (e.g., bend outwardly) when a spreader is inserted into the central
bore 2265 of the anchor body 2200. The expandable segments are configured to engage
with soft tissue and bone, fixedly securing the anchor body 2200 and the soft tissue
in the bone. In some embodiments, the expandable segments 2220 comprise one or more
protrusions 2222 (teeth, ridges, etc.) which are configured to further engage with
the tissue and bone. The number of expandable segments 2220 and teeth 2222 can vary.
The expandable segments 2220 are affixed to the tubular wall along an edge 2224. The
edge 2224 is configured to allow pivotal movement about the tubular wall 2210 such
that the tines 2222 are bendable between a compressed state and an expanded state.
In some embodiments, such as that shown in Figure 12, the expandable segments 2220
and edges 2224 are oriented and configured such that upon expansion, a distal end
of the expandable segments 2220 experiences the greatest displacement.
[0069] Figure 13 depicts the spreader 2300 of the tissue anchoring device 2100. In some
embodiments, the spreader 2300 includes a conical portion 2310 and a tubular portion
2320. In other embodiments, the spreader 2300 is entirely tubular or conical. In some
embodiments, a flattened, grooved portion 2325, or similar feature, is present on
an outer surface of the spreader 2300 to complement a feature within the central bore
2265 of the anchor body 2200, and thus align the orientation of the spreader 2300
within the bore 2265. Such alignment features restrict axial and rotational movement
of the spreader 2300. The spreader 2300 of various embodiments also includes a hole
2330 for receiving an insertion tool.
[0070] Figure 14 depicts the tissue anchoring device 2100 in an expanded state. As in other
embodiments, the spreader 2300 is insertable into the central bore 2265 at the proximal
end of the anchor body 2200 and configured to urge the expandable segments 2220 and
expandable proximal portion 2205 radially outward relative to the tubular wall 2210
upon insertion of the spreader 2300 into the central bore. Such radial expansion on
both a proximal portion and a distal portion allows for improved fixation of the tissue
anchoring device 2100, including fixation within a proximal aperture of a bone tunnel
and a distal aperture of the bone tunnel.
[0071] In various embodiments of the tissue anchoring devices disclosed herein, the tissue
anchoring device is made entirely of a biocompatible engineering plastic. Other embodiments
include a tissue anchoring device made entirely, or in part, of a biocompatible non-metallic
substance. Biocompatible engineering polymer materials such as polyether-ether-ketone,
poly-ether-ketone, polyetherimide, ultrahigh molecular weight polyethylene, polyphenylene,
poly(lactide-co-glycolide), polycaprolactone, or some other biocompatible polymer
material known to those of skill in the art may be used. A non-metallic anchor system
may provide certain advantages such as, for example, eliminating MRI artifacts.
[0072] Figure 15A depicts individual components of an inserter tool, which may, in some
embodiments, be used with any tissue anchoring device design disclosed herein. The
inserter tool 3000 comprises an inner rod or tube 3500, an outer tube 3600, a handle
body 3700, a threaded actuator shaft 3800, and a deployment knob 3900. In some embodiments,
the inserter tool 3000 is coupled to the tissue anchoring device 3100 during manufacturing.
In a preferred embodiment, the inserter tool is disposable.
[0073] The inserter tool 3000 is designed to insert and manipulate a tissue anchoring device,
such the tissue anchoring device described above. In some embodiments, the tissue
anchoring device is manufactured to be attached to the inserter tool before packaging.
In other embodiments, the tissue anchoring device is coupled to the inserter tool
shortly prior to insertion. In a basic configuration, the inserter tool is assembled
as follows: the inserter tool 3000 is configured such that the inner rod 3500 is disposed
within the outer tube 3600. The outer tube is configured to fit against the proximal
end of the spreader 3300. The inner rod 3500 extends through outer tube 3600 and is
configured to attach to the distal end of the anchor body 3200 via threading on both
the distal hole in the anchor body 3200 and threading on the distal end of the inner
rod 3500. The proximal end of the outer tube 3600 is connected to a handle 3700 and
the inner rod 500 extends through the proximal end of the outer tube 3600 and screws
into the threaded actuator shaft 3800. The actuator shaft 3800 extends just past the
proximal end of the handle 3700 where it is configured to secure with a deployment
knob 3900.
[0074] The individual components of the inserter tool 3000 are further described in detail
below. The inserter tool 3000 may be used with any embodiment of a tissue anchoring
device. For ease of description, in the description that follows, the inserter tool
3000 is described with reference to tissue anchoring device 100.
[0075] Figure 15B shows a perspective view of an embodiment of the inner rod 3500. In some
embodiments, the inner rod is an inner tube. The inner rod comprises a rod-like or
tube-like body 3525, a distal end 3510 configured to secure to a tissue anchoring
device spreader 300, and a proximal end 3520 which is configured to interact with
the other components of the inserter such as the actuator shaft 3800. The inner rod
3500 is configured such that a proximal end 3520 is advanced through the outer tube
3600 and into the handle 3700 where it is further secured within the actuator shaft
3800 via threading. The distal end of the inner rod 3500 is configured to extend through
the central bore in a spreader 300 and an anchor body 200 and then be secured to the
distal end of the anchor body 200. Upon activation, the inner rod is retracted until
the tissue anchoring device is fully deployed and the inner rod is separated from
the anchor.
[0076] The inner rod 3500 extends through the central bore in the spreader 300 and the anchor
body 200 before coupling with the distal end of the anchor body 200. In one embodiment,
the inner rod 3500 couples with the anchor body 200 through threads 3505 on the end
of the inner rod 3500 and within the distal end of the anchor body 200. In other embodiments,
the inner rod 3500 may couple to the anchor body 200 through other securing mechanisms
such as adhesives, welding or frictional fit.
[0077] Figure 15C shows an embodiment of the outer tube 3600. The outer tube 3600 is attached
at its proximal end 3605 to the distal end of handle 3700 via threading 3625. The
distal end 3610 of the outer tube 3600 is configured such that the inner rod 3500
can be drawn into the outer tube 3600 through the distal end 3610 of outer tube 3600.
When the inner tube 3500 is advanced far enough that the spreader 300 locks into place
or cannot advance anymore, the distal surface of the outer tube 3600 may be level
with the proximal surface of the anchor body 200. When the inner rod 3500 withdraws
further into the outer tube upon the continued rotation of the deployment knob and
advancement of the actuator shaft, the inner rod 3500 strips the threading from the
anchor body 200 and the inserter tool 3000 detaches from the tissue anchoring device
100.
[0078] Figures 15D and 15E show embodiments of a handle body 3700. Figure 15D is a cross-sectional
view of one embodiment of a handle 3700 and 15E is a cut-away view of the handle body
3700. The proximal end of the handle 3700 is configured to receive the deployment
knob 3900 via the ridges 3730 which hold the knob 3900 secure. The actuator shaft
3800 is housed within the handle body 3700. A set of brackets or braces 3710 each
having a flat surface 3715 secure the actuator shaft 3800 within the handle 3700.
The distal end 3770 of the handle is configured to receive the outer tube 3600 via
threads 3725 in opening 3740. The outer tube 3600 is permanently affixed to the handle
3700 at its distal end.
[0079] Figure 15F depicts the threaded actuator shaft 3800. The actuator shaft 3800 is comprised
of a distal end 3805 comprising a threaded hole 3810 which is configured to receive
the inner rod 3500, a second threaded portion 3825 on the body of the shaft configured
to advance the inner rod 3500, and a proximal end 3820 configured to secure within
the deployment knob 3900. The threading 3825 of the actuator 3800 has two flat areas
3830, one on each side, where there is no threading. These flat areas 3830 fit within
the flat brackets 3710 of the handle such that the actuator 3800 cannot rotate within
the handle.
[0080] The body of the actuator shaft 3800 is configured with threading 3825 to permit the
shaft 3800 to advance the inner tube 3500. The body of the actuator shaft 3800 is
not perfectly round, but rather is oval shaped with flat sides 3830 that fit into
the handle body 3700 in such a way that the actuator shaft 3800 cannot itself rotate
when the deployment knob 3900 is turned and the shaft 3800 advances via knob 3900.
Thus, the threads do not go all the way around the shaft but rather flatten out on
the flattened sides of the shaft. The actuator shaft is configured as a coaxial system.
That is, the spreader 3300, inner tube 3500 and actuator 3800 are configured to operate
as one piece. The flat brackets 3710 in the handle make the actuator shaft 3800 stay
on plane such that the actuator shaft 3800 itself cannot rotate within the handle
3700. The proximal end of the inner tube 3500 couples with the distal end of the actuator
shaft 3800 via threading.
[0081] Figure 15G depicts a deployment knob 3900. The deployment knob 3900 comprises a central
hole 3910 which is configured with threading 3905, and a groove 3930 configured to
be received by a corresponding ridge 3730 of the handle 3700. The threading 3905 in
the central hole 3910 is configured to receive the actuator shaft 3800. The deployment
knob 3900 is configured to advance, relative to the deployment knob 3900, the inner
rod 3500 via the actuator shaft 3800. The actuator shaft 3800 is joined at its proximal
end to the distal end of the deployment knob 3900 via threading 3905 in the central
hole 3910. The actuator shaft 3800 is attached to the inner rod 3500 by way of the
proximal end of the inner rod 3500 advancing into the distal end of the actuator shaft
via threading so that when the deployment knob 3900 is rotated, the mechanism of the
shaft 3800 advances the inner rod 3500 proximally such that the spreader 300 is then
advanced into the anchor body 200 to expand the anchor body 200 into bone and secure
the tissue anchoring device 100.
[0082] In one embodiment, the deployment knob 3900 is threaded 3905 to receive the actuator
shaft via the groove 3930 of knob 3900 fitting with the proximal end ridge 3730 of
the handle body 3700. As the deployment handle is turned, the actuator shaft 3800
is advanced in a proximal direction until the anchor body 200 is deployed and locked
into place.
[0083] When in the position for deployment, the inner rod 3500 is positioned within the
outer tube 3600, and the outer tube is flush with the anchor body 200. The inner rod
3500 may hold the anchor body 200 steady during insertion and deployment. The inner
rod 3500 extends through the spreader 300 and couples to the anchor body 200 via threading.
The spreader 300 is configured to be advanced distally through the proximal end of
the anchor body 200 by the retraction of the inner rod 3500 via rotating the deployment
knob 3900, which pulls the anchor body 200 proximally relative to the spreader 300.
[0084] The outer tube 3600 provides the mechanism to push the spreader 300 into the central
bore 265 in the anchor body 200 to fully expand the anchor body 200. During deployment
of the tissue anchoring device, the inner rod 3500 is continually retracted via a
screwing motion until the spreader 300 locks into the anchor body 200. As the deployment
knob 3900 continues to turn and the inner rod 3500 continues to pull on the threads
of the anchor body 200, the inner rod 3500 strips the threads from the inside of the
anchor body 200 and the insertion tool 3000 releases from the anchor body 200. Any
thread shavings are contained within the outer tube 3600.
[0085] In some embodiments, a pre-attached delivery handle is provided. In some embodiments,
the insertion tool or delivery handle is disposable. In other embodiments, the insertion
tool can be sterilized, reloaded, and reused.
[0086] Those of skill in the art will appreciate other inserters and mechanisms that may
be used to insert and deploy the tissue securing anchor described herein. Although
a particular insertion device for inserting and manipulating a tissue anchoring device
has been described, it should be understood that other inserter designs may be used
for manipulating the tissue anchoring device described above in order to insert the
anchor and soft tissue into bone. For example, it may be possible to use separate
tools for inserting the anchor, securing soft tissue, and securing the anchor.
[0087] The anchors described above may be used to secure a tissue graft in an ACL repair.
In some embodiments, the anchors described above are used to anchor tissue in a bone
tunnel in the tibia. In such procedures, the tissue graft is first anchored within
a bone tunnel in the femur. Any suitable anchor may be used to secure tissue to the
femur. In some embodiments, suitable anchors include a tissue grasping feature that
can be used to capture tissue and feed it through bone tunnels in the tibia and/or
femur. In some embodiments, the tissue grasping feature includes a suture loop that
can be tightened around one or more strands of tissue.
[0088] One example of such a suture loop anchor 4000 is depicted in Figures 16A and 16B
and described in more detail in Figures 13A-16B in
U.S. Patent Application Publication No. 2011-0112550, which is incorporated herein by reference in its entirety. Figure 16A depicts the
femoral anchor 4000 in an undeployed state with suture loop ready to capture tissue.
After tissue capture and insertion in the femur, lateral protrusions on the anchor
4000 may be deployed to secure the anchor and issue into the femur. Figure 16B depicts
the femoral anchor 4000 in its deployed state.
[0089] In other embodiments, a modified version of the tibial anchor described above may
be used as the femoral anchor. One such embodiment of a femoral anchor 5000 is depicted
in Figure 17. In this case, instead of a rounded distal end, the anchor body 5100
comprises a flat, depressed, or saddle shaped distal end 5106. Two apertures or provided
in the distal end 5106 to accommodate the treading of a suture to form a suture loop
5200 in the distal end. As in the anchor described in Figures 16A and 16B, tissue
may be captured within the suture loop 5200, the suture tightened, and then the anchor
5000 with captured tissue inserted into the femoral bone tunnel. The anchor 5000 may
be deployed using the same spreader and inserter as described above for the tibial
anchor.
[0090] Those of skill in the art will appreciate other suitable femoral anchors for use
in combination with the tibial anchor described herein in performing a torn ACL repair.
[0091] Figures 18A-18D depict some non-limiting suitable ACL repair techniques utilizing
the anchors described herein. First, as depicted in Figure 18A, a bone tunnels 6100
and 6200 are formed in the tibia and femur, respectively. In some embodiments, both
tunnels 6100 and 6200 are formed using a single drill drilling through the tibia and
then into the femur. In other embodiments, the femoral tunnel 6200 and tibial tunnel
6100 may be formed separately. Next, a surgeon obtains a suitable tissue graft 6300,
which may include tendon from the patient (e.g., one or more patellar or hamstring
tendons), from a cadaver, or a synthetic graft. The tissue graft 6300 is then captured
by a femoral anchor 1100, such as, for example, any of the anchors 4000, 5000 described
in Figures 16A-17. The femoral anchor 4000 (as an example) is then inserted into the
femoral tunnel 6200 and deployed to secure the graft 6300 into the femur.
[0092] In one embodiment, as depicted in Figure 18B, a lateral technique is used whereby
the surgeon inserts the femoral anchor 4000 with captured tissue graft 6300 laterally
into the space between the femur and tibia. The femoral anchor 4000 is then inserted
directly into the femoral bone tunnel 6200. The joint may be abducted to facilitate
direct insertion in the femoral tunnel 6200. After insertion of the femoral anchor
4000, the tissue graft 6300 may then be fed down through the tibial bone tunnel 6100
and out the other side resulting in the configuration depicted in Figure 18C. In one
technique, a suture loop is fed up through the tibial tunnel 6100, the graft 6300
is fed through the loop, and then the loop is pulled back through the tibial tunnel
6100, drawing the graft 6300 with it.
[0093] In an alternative embodiment, an in-line approach may be used where the femoral anchor
4000 with captured tissue graft 6300 is inserted through the tibial bone tunnel 6100
and then into the femoral bone tunnel 6200. The result is graft 6300 running from
the femoral anchor 4000 through and out of the tibial tunnel 6100 as depicted in Figure
18C.
[0094] After achieving the configuration of Figure 18C, the joint may be positioned and
the tissue graft 6300 tensioned as appropriate. Next, as depicted in Figure 18D, a
tibial anchor (for example, tibial anchor 100) as described herein may be inserted
into the opening of the tibial bone tunnel 6100 and deployed to secure the graft 6300
to the tibia. Excess graft 6300 may then be trimmed to be flush with the tibial anchor
100. As shown in Figure 18D, in some embodiments, the tibial anchor 100 is configured
to extend substantially the length of the tibial bone tunnel 6100. In some embodiments
of the tissue anchoring device 100 disclosed herein, expansion of the tibial anchor
100 is relatively uniform. In other embodiments, the tissue anchoring device is configured
to expand at various locations along the length of the tibial anchor 100. Thus, the
use of any of the above-described tibial anchors for ACL repair procedures may advantageously
allow for fixation of the tissue to bone throughout the length of the tibial bone
tunnel 6100. In various embodiments, the length of the anchor is greater than about
30 mm, greater than about 35 mm, greater than about 40 mm, or about 45 mm.
[0095] In one embodiment of a method of ACL repair, the tibial anchor 100 may be inserted
into the opening of the tibial bone tunnel 6100 and pushed through distally until
at least a distal tip of the tibial anchor 100 emerges on the other side of the tibial
bone tunnel 6100. In such embodiments, the tibial anchor 100 is then pulled proximally
back until the distal tip of the tibial anchor 100 is no longer visible. Such an insertion
mechanism ensures the tibial anchor 100 is properly sized and placed in the bone tunnel
such that the tibial anchor 100 extends substantially the length of the tibial bone
tunnel 6100. In some embodiments, such placement will allow for aperture fixation
of the tibial anchor 100 at both a distal opening and a proximal opening of the tibial
bone tunnel 6100.
[0096] Additionally or alternatively, in one embodiment of a method of ACL repair, the tibial
bone tunnel 6100 is measured to determine its length. In some such embodiments, a
measurement tool or guide is inserted into the tibial bone tunnel 6100 after formation.
The length of the bone tunnel 6100 is detected, and an appropriately-sized tibial
anchor (for example, tibial anchor 100) is selected to fit substantially the entire
length of the bone tunnel 6100. The anchors and tissue are then inserted in accordance
with the methods described in relation to Figures 18B-18D. In some such embodiments,
an anchor having a length greater than 25mm is selected. In some embodiments, an anchor
having a length of approximately 30mm, 45mm, 50mm, or any value therebetween is selected.
[0097] Advantageously, aperture fixation at both a distal opening and a proximal opening
of the tibial bone tunnel 6100 may allow for engagement of the tibial anchor 100 (and
consequently, the tissue 6300) with both cancellous bone and cortical bone at both
ends of the tibial anchor 100. Fixation within the softer outer bone portion of the
tibia may lead to better bone growth around the anchor 100 and the tissue, ensuring
a secure connection at both ends. In some embodiments, aperture fixation of the tibial
anchor at both the distal and proximal sides helps minimize wear on, and irritation
of, the tissue 6300; it may reduce the "windshield wiper" effect that can occur when
one end of an anchor loosens; and it may also improve the healing process and reduce
the risk of anchor failure by increasing the contact between the tissue 6300 and the
tibial bone.
[0098] In some embodiments, the approach described above is conducted using a single strand
of tissue graft 6300. In this case, the graft 6300 may be captured by the femoral
anchor 4000 and doubled over the end of the femoral anchor 4000 such that two parallel
portions of the graft 6300 run from the femoral anchor 4000 to the tibial anchor 100.
In other embodiments, two strands of tissue graft 6300 may be doubled over the end
of the femoral anchor 4000 resulting in four parallel portions of graft 6300 running
from the femoral anchor 4000 to the tibial anchor 100.
[0099] Although ACL repair techniques have been described herein, it will be appreciated
that the anchors described may be used in any number of procedures where a surgeon
desires to fix soft tissue to bone.
[0100] For purposes of summarizing the disclosure, certain aspects, advantages and features
have been described herein. It is to be understood that not necessarily all such advantages
may be achieved in accordance with any particular embodiment. Thus, the invention
may be embodied or carried out in a manner that achieves or optimizes one advantage
or group of advantages as taught herein without necessarily achieving other advantages
as may be taught or suggested herein.
[0101] While this invention has been described in connection with what are presently considered
to be practical embodiments, it will be appreciated by those skilled in the art that
various modifications and changes may be made without departing from the scope of
the present disclosure. It will also be appreciated by those of skill in the art that
parts mixed with one embodiment are interchangeable with other embodiments; one or
more parts from a depicted embodiment can be included with other depicted embodiments
in any combination. For example, any of the various components described herein and/or
depicted in the Figures may be combined, interchanged or excluded from other embodiments.
With respect to the use of substantially any plural and/or singular terms herein,
those having skill in the art can translate from the plural to the singular and/or
from the singular to the plural as is appropriate to the context and/or application.
The various singular/plural permutations may be expressly set forth herein for sake
of clarity.
[0102] While the present disclosure has described certain exemplary embodiments, it is to
be understood that the invention is not limited to the disclosed embodiments, but,
on the contrary, is intended to cover various modifications and equivalent arrangements
included within the scope of the appended claims, and equivalents thereof.